Communication

I think a lot of health professionals are very good at focussing on their specific treatment and management of a patient, but I think there is room for improving communication with other health professionals and working within a team environment. In the rural setting this communication sometimes breaks down all together as there is a very high turn over of staff and information is not always passed on appropriately.

While on my rural placement I visited a remote community for a day each week and part of that visit was to cover a small hospital with four beds. “Mike” had been admitted about three months prior with progressive weakness and atrophy of his lower limbs, after his family were unwilling to care for him anymore. Mike had a history of alcohol and substance abuse and the medical staff believed that this was an expression of a long standing mental illness and was treated accordingly.

The hospital was staffed by agency nurses who rotated every few weeks and a RMO who covered the hospital along with private rooms in two communities. When we made our weekly visit to the hospital to see Mike along with another patient we were informed that the RMO had resigned effective immediately and that a replacement doctor had started the day before. This resignation had also coincided with a change in the nursing staff.

We had read in Mike’s notes the week previously he was going to be seen by a visiting specialist as the current treatment was not working and no definitive diagnosis had been made. However when we arrived at the hospital we found that Mike had been taken to the regional hospital in order to have some additional investigations done that were ordered by the new doctor, unaware of the visit by the specialist. This meant that as the specialist was driving to the remote centre, Mike was in an ambulance driving the other way.

The additional investigations provided no further information and Mike did not get to see another specialist until over two weeks later. By that time he had deteriorated further and after review from the specialist Mike was diagnosed with an aggressive form of cancer that had spread to his spine and lungs.

I found this experience really highlighted to me again the challenges health professionals face in a rural setting with staff turn over and logistics, but more importantly it showed that when everyday things we take for granted do not happen, such as basic communication about the care of a patient, then there can be significant consequences for the patient. In this scenario I am not sure finding the cancer two weeks earlier would have helped, but I do think it is a shame the patient was at not least given that chance.